Aim
To examine tuberculosis incidence rates among the elderly in Central Serbia in 1992-2006 period, which was characterized by socioeconomic crisis and migration of population.
Methods
We analyzed all reported active tuberculosis cases in a 15-year period, especially among patients aged ≥65, according to the Annual Reports of the Institute of Lung Diseases and Tuberculosis in Belgrade and Central Tuberculosis Register. Population estimates with extrapolations were based on 1991 and 2002 census data.
Results
Total tuberculosis incidence rates showed a slight but non-significant decreasing trend (
P = 0.535), and no significant increase was found in patients aged ≥65 years (
P = 0.064), with an average age-specific incidence rate for the elderly of 64.0 (95% confidence interval, 60.7-67.4). The increase was significant in patients aged ≥70 years (y = 49.3549 + 2.1186x;
P = 0.001), both in men (y = 62.8666 + 2.3977x;
P = 0.005) and even more prominently in women (y = 39.8240 + 1.9150x;
P < 0.001). The proportion of tuberculosis cases in the elderly peaked in 2005, with 35% of all tuberculosis cases.
Conclusion
High incidence rates and increasing time trend of tuberculosis in the elderly in Central Serbia is a serious problem, especially among those aged 70 years and over, who might present a target group for active case-finding of the disease.Tuberculosis is an infectious disease caused by
Mycobacterium tuberculosis complex. It can affect persons of any age and involve any site in the body. The risk of developing tuberculosis depends both on the risk of being infected and the risk of developing the active form of the disease. The former depends on the tuberculosis prevalence in the community, whereas the latter depends on many genetic and environmental factors (
1-
3). A total of 8-10 million people worldwide develop active tuberculosis per year, while at least 1.7 million people die from this disease (
4,
5). In 1993, the World Health Organization declared tuberculosis a global problem. The main reasons for this are the dramatically increasing number of immune-deficient people in the world and the problem of multi-drug resistant tuberculosis (
5,
6). In Europe, two tuberculosis trends can be observed, one being a declining epidemic in the west and the other an increasing one in the east (
4).While human immunodeficiency virus (HIV) infection presents the greatest single risk factor for developing active tuberculosis, in countries with low HIV prevalence, other factors that decrease human immunity are of higher importance. All tuberculosis risk factors are more pronounced and even multiplied in patients belonging to tuberculosis risk groups, such as immigrants/refugees, prisoners, elderly in old-age homes, people with disabilities in asylums, and Roma populations in slums (
3,
7-
9). Tuberculosis in the elderly is an increasing problem in many countries (
4), because of age-related decline in immunity (
1) and increasing longevity (
10). While the latter happens predominantly in developed countries, the elderly in developing countries suffer from poverty, malnutrition and tobacco smoking, which are proven risk factors for tuberculosis (
1,
11,
12). Thus, tuberculosis in the elderly is likely to be a lasting and even an increasing problem worldwide.Serbia is a country with intermediate tuberculosis incidence rate (
4,
13,
14). A molecular epidemiologic analysis, performed in Belgrade, showed a recent frequent transmission of tuberculosis (
15). The national tuberculosis mortality data show peak numbers in the elderly (
16,
17). In the 1990s, Serbia faced socio-economic crisis, civil war, and mass migration of population following disintegration of former Yugoslavia. We investigated whether tuberculosis in the elderly in Serbia increased in the 1992-2006 period.
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